1,721,181 research outputs found
'Partners in pain'--the game of painmanship revisited
No full textChronic low back pain is common in primary care, and there is no doubt that some of its manifestations are demoralizing and dispiriting for the GP.1 Sufferers often present without identifiable organic pathology, and their condition appears intractable. Here we suggest that GPs' own ideas about the consultation and the moral nature of the doctor–patient relationship in general practice may themselves go some way towards constructing this ‘intractable’ state. Our objective is to reflect on the possibility that current ideas about good clinical practice might themselves be iatrogenic
Managing depression in primary care: another example of the inverse care law?
No full textBackground: depression is a common problem, often being recurrent or becoming chronic. The National Service Framework for Mental Health (published by the Department of Health, 1999) states that people with depression should continue to be predominantly managed in primary care. There is much evidence that the detection and management of depression by GPs could be improved, but little work has focused on GPs’ views of their work with depressed patients.Objectives: this was a qualitative study exploring GP attitudes to the management of patients with depression. Views of GPs in socio-economically deprived areas are compared with those serving more affluent populations.Methods: semi-structured interviews were conducted with two groups of GPs in north-west England. One group of GPs (22) were practising in inner-city areas, and a second group (13) in suburban and semi-rural practices. All were Principals in practices that participated in undergraduate teaching. The interviews were audio-taped and subsequently transcribed verbatim. Analysis was by constant comparison until category saturation of each theme was achieved.Results: subjects conceptualized depression as an everyday problem of practice, rather than as an objective diagnostic category. Thematic coding of their accounts suggests a tension between three kinds of views of depressed people: (i) That depression is a common and normal response to life events or change and that it reflects the medicalization of these conditions; (ii) That the label or diagnosis of depression offers a degree of secondary gain to both patients and doctors, particularly to those GPs practising in inner-city areas and (iii) That inner-city GPs experienced on-going management of depressed people as an interactional problem, in contrast to those GPs serving a less deprived population who saw depression as a treatable illness and as rewarding work for the GP.Conclusion: depression is commonly presented to GPs who feel that the diagnosis often involves the separation of a normal reaction to environment and true illness. For those patients living in socio-economically deprived environments, the problems, and therefore the depression, are seen to be insoluble. This has an important implication for the construction of educational interventions around improving the recognition and treatment of depression in primary care: some doctors may be reluctant to recognize and respond to such patients in depth because of the much wider structural and social factors that we have suggested in this paper. That it is the doctors working with deprived populations who express these views, means that the ‘Inverse care law’ [Tudor Hart J. The inverse care Law. Lancet 1971; 1(7696): 405–412] operates in the management of depressio
Having diabetes and having to fast: a qualitative study of British Muslims with diabetes
No full textBackgroundThere are approximately 2.7 million Muslims in the UK, constituting 4.8% of the population. It is estimated that 325 000 UK Muslims have diabetes. Whilst dietary practices of Muslims with diabetes have been explored, little work has described the beliefs and decisions to fast during Ramadan, whereby Muslims with diabetes refrain from eating, drinking and taking medication between sunrise and sunset. ObjectiveTo explore beliefs and experiences of fasting during Ramadan of Muslim respondents with diabetes and their perceptions of the role played by their general practitioner (GP) and/or practice nurse (PN) in supporting them. DesignQualitative study.SettingGeneral practices and community groups located in Greater Manchester.Participants23 South Asian Muslims.MethodsSemi‐structured interviews were conducted as part of the Collaboration of Applied Health Research and Care (CLAHRC) programme, Greater Manchester. Respondents were recruited using random and purposive sampling techniques. Interviews were analysed thematically using a constant comparison approach. ResultsThirteen respondents reported they fasted and altered diabetes medication and diet during Ramadan. The decision to fast was influenced by pressures from the family and the collective social aspect of fasting, and respondents made limited contact with primary care during fasting. ConclusionTensions exist between the respondent's personal desire to fast or not fast and their family's opinion on the matter, with a strong reluctance to disclose fasting to GP and/or PN. Future research needs to explore whether GPs or PNs feel competent enough to support patients who wish to fast. <br/
Sickness certification system in the United Kingdom: qualitative study of views of general practitioners in Scotland
Full text linkObjectives: To explore how general practitioners operate the sickness certification system, their views on the system, and suggestions for change.
Design: Qualitative focus group study consisting of 11 focus groups with 67 participants.
Setting: General practitioners in practices in Glasgow, Tayside, and Highland regions, Scotland.
Sample: Purposive sample of general practitioners, with further theoretical sampling of key informant general practitioners to examine emerging themes.
Results: General practitioners believed that the sickness certification system failed to address complex, chronic, or doubtful cases. They seemed to develop various operational strategies for its implementation. There appeared to be important deliberate misuse of the system by general practitioners, possibly related to conflicts about roles and incongruities in the system. The doctor-patient relationship was perceived to conflict with the current role of general practitioners in sickness certification. When making decisions about certification, the general practitioners considered a wide variety of factors. They experienced contradictory demands from other system stakeholders and felt blamed for failing to make impossible reconciliations. They clearly identified the difficulties of operating the system when there was no continuity of patient care. Many wished either to relinquish their gatekeeper role or to continue only with major changes.
Conclusions: Policy makers need to recognise and accommodate the range and complexity of factors that influence the behaviour of general practitioners operating as gatekeepers to the sickness certification system, before making changes. Such changes are otherwise unlikely to result in improvement. Models other than the primary care gatekeeper model should be considered
A coproduced patient and public event: An approach to developing and prioritizing ambulance performance measures
Full text linkBackground
Patient and Public Involvement (PPI) is recognised as an important component of high quality health
services research. PPI is integral within the Pre-hospital Outcomes for Evidence Based Evaluation
(PhOEBE) programme. The PPI event described in detail in this paper focusses on the process of
involving patients and public representatives in identifying, prioritising and refining a set of outcome
measures that can be used to support ambulance service performance measurement.
Objective
To obtain public feedback on little known, complex aspects of ambulance service performance
measurement.
Design
The event was co-designed and co-produced with the PhOEBE PPI reference group and PhOEBE
research team. The event consisted of: brief researcher-led presentations, group discussions
facilitated by the PPI reference group members and electronic voting.
Setting and participants
Data were collected from eighteen patient and public representatives who attended an event venue
in Yorkshire.
Results
The results of the PPI event showed that this interactive format and mode of delivery was an
effective method to obtain public feedback and produced a clear indication of which ambulance
performance measures were most highly favoured by event participants.
Discussion and Conclusions
The event highlighted valuable contributions the PPI reference group made to the design process,
supporting participant recruitment and facilitation of group discussions. In addition, the positive
team working experience of the event proved a catalyst for further improvements in patient and
public involvement within the PhOEBE project
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Multiple somatic symptoms predict impaired health status in functional somatic syndromes
No full textBackground: The relationship between functional somatic syndromes and multiple somatic symptoms is unclear. Purpose: We assessed whether the number of somatic symptoms is a predictor of health status in three functional somatic syndromes (FSS). Methods: In a population-based study of 990 UK adults we assessed chronic widespread pain (CWP), chronic fatigue (CF) and irritable bowel syndrome (IBS) by questionnaire and medical record data. We assessed health status (Short Form 12 and EQ-5D), number of somatic symptoms (Somatic Symptom Inventory) and anxiety/depression (Hospital Anxiety and Depression Scale) both at baseline and at follow-up 1 year later. Results: The proportion of people with an FSS who also have multiple somatic symptoms (52-55 %) was similar in the three functional syndromes. The presence of multiple somatic symptoms was associated with more impaired health status both at baseline and at follow-up. This finding was not explained by severity of FSS. In the absence of multiple somatic symptoms, the health status of the FSS was fair or good. In multiple regression analysis, the number of somatic symptoms, the presence of a functional syndrome (CWP or CF) and anxiety/depression were predictors of EQ-5D thermometer at follow-up after adjustment for confounders. Conclusions: Multiple somatic symptoms in people with an FSS are associated with impaired health status and this cannot be explained by more severe functional syndrome or the presence of anxiety and depression. © 2012 International Society of Behavioral Medicine
`They Are Still the Same as You on the Outside Just a Bit Different on the Inside': Raising Awareness of Dementia Through the School Curriculum
No full textWhilst memory loss is a significant feature of dementia, it is important to remember that people experience dementia in very unique and individual ways. In addition to physical symptoms, people living with dementia can be impacted upon by a range of behavioural and psychological symptoms which are debilitating for the person experiencing them and challenging for those around them, whether in a familial or caring capacity. Behaviour is often misunderstood when it is not considered within the context of a person's individual life history. Following a person-centred approach is therefore an essential part of appreciating someone's identity and identifying the underlying reason for the behaviour
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